Healthcare Provider Details

I. General information

NPI: 1558344432
Provider Name (Legal Business Name): THOMAS W EADES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKLYN AVE SUITE 200
SAN ANTONIO TX
78212-4829
US

IV. Provider business mailing address

1200 BROOKLYN AVE SUITE 200
SAN ANTONIO TX
78212-4803
US

V. Phone/Fax

Practice location:
  • Phone: 210-225-4566
  • Fax: 210-212-2187
Mailing address:
  • Phone: 210-225-4566
  • Fax: 210-212-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE3550
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number6649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: